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Plasmacytoma of the Cervical Spine

By |December 7, 2017|Diagnosis|

Plasmacytoma of the Cervical Spine: A Case Study

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2017 (Jun); 16 (2): 170–174

Richard Pashayan, DC, DABCO, CCSP,
Wesley M. Cavanaugh, DC,
Chad D. Warshel, DC, DACBR, and
David R. Payne, MD

Private Practice,
Flushing, NY.


OBJECTIVE:   The purpose of this case study is to describe the presentation of a patient with plasmacytoma.

CLINICAL FEATURES:   A 49-year-old man presented with progressive neck pain, stiffness, and dysphagia to a chiropractic office. A radiograph indicated a plasmacytoma at C3 vertebral body. The lesion was expansile and caused a mass effect anteriorly on the esophagus and posteriorly on the spinal cord. Neurologic compromise was noted with fasciculations and hypesthesia in the right forearm. The patient was referred to a neurosurgeon.

INTERVENTION AND OUTCOME:   Surgical resection of the tumor was performed with a vertebral body spacer and surrounding titanium cage. Bony fusion was initiated by inserting bone grafts from the iliac crests into the titanium cage. Additional laboratory analysis and advanced imaging confirmed that the plasmacytoma had progressed to multiple myeloma and radiation and chemotherapy were also necessary.

There are other articles like this @ our:

Case Reports Section

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Chiropractic Gains Ground During Texas Legislative Session

By |June 1, 2017|Diagnosis|

Chiropractic Gains Ground During Texas Legislative Session

The Chiro.Org Blog


SOURCE:   Texas Chiropractic Association ~ May 30, 2017


Texas Gov. Greg Abbott signed into law Senate Bill 304, continuing the Texas Board of Chiropractic Examiners (TBCE) and upholding the right of licensed doctors of chiropractic in Texas to diagnose patients. It caps a historic legislative session for the chiropractic profession in Texas.

The Texas Board of Chiropractic Examiners is a state agency that regulates the chiropractic profession in Texas. Along with other state health care agencies, TBCE was under review by the Texas Sunset Advisory Commission last year. With the governor’s signature, the state’s chiropractic board will continue through Sept. 1, 2029, in addition to several other modifications to increase patient safety.

Also included in the bill was specific language to be incorporated into the Texas Chiropractic Act that clarifies the right of Texas chiropractors to diagnose. This nullifies a 2016 decision by the Travis County District Court in the Texas Medical Association vs. Texas Board of Chiropractic Examiners law suit in which diagnosis was deemed to exceed the scope of practice. With the signing of Senate Bill 304, the matter of diagnosis is settled.

“If the district court’s ruling had been allowed to stand, Texas would have been the only state in which chiropractors are not allowed to diagnose,” said Tyce Hergert, DC, of Grapevine, Texas, president of the Texas Chiropractic Association (TCA) and a chiropractor who practices in Southlake, Texas. “Without this right, it would endanger patient safety and potentially affect insurance reimbursement. We thank the governor for recognizing the importance of this issue and creating greater access to chiropractic care for the citizens of Texas.”

TCA is awaiting the governor’s signature on two other key bills:

There are background articles about the Texas Diagnosis battle @ our:

Prescription Rights and
Expanded Practice Page

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Mechanisms of Low Back Pain:
A Guide for Diagnosis and Therapy

By |October 30, 2016|Diagnosis, Low Back Pain|

Mechanisms of Low Back Pain:
A Guide for Diagnosis and Therapy

The Chiro.Org Blog


SOURCE:   F1000Res. 2016 (Oct 11); 5. pii: F1000

Massimo Allegri, Silvana Montella, Fabiana Salici,
Adriana Valente, Maurizio Marchesini, Christian Compagnone,
Marco Baciarello, Maria Elena Manferdini, and Guido Fanelli

Department of Surgical Sciences,
University of Parma,
Parma, Italy


Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety. Given this complexity, the diagnostic evaluation of patients with CLBP can be very challenging and requires complex clinical decision-making.

Answering the question “what is the pain generatoramong the several structures potentially involved in CLBP is a key factor in the management of these patients, since a mis-diagnosis can generate therapeutical mistakes. Traditionally, the notion that the etiology of 80% to 90% of LBP cases is unknown has been mistaken perpetuated across decades. In most cases, low back pain can be attributed to specific pain generator, with its own characteristics and with different therapeutical opportunity. Here we discuss about radicular pain, facet joint pain, sacro-iliac pain, pain related to lumbar stenosis, discogenic pain. Our article aims to offer to the clinicians a simple guidance to identify pain generators in a safer and faster way, relying a correct diagnosis and further therapeutical approach.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

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Life-Threatening Lower Back Pain

By |January 8, 2016|Diagnosis, Low Back Pain|

Life-Threatening Lower Back Pain –
Decoding the Mystery Step-By-Step

The Chiro.Org Blog


SOURCE:   A Chiro.Org Contribution


David J Schimp DC, DACNB, DAAPM, FICCN and
Stefanie Krupp DC, MS

David J Schimp DC
Schimp Office of Chiropractic Professionals LTD
937 E. Sumner St.
Hartford, WI 53027 USA


This article will help clinicians identify life-threatening conditions that present with lower back pain.


Intra-abdominal bleed (e.g. aortic aneurysm), infection and tumor are the most dangerous causes of lower back pain and carry the potential for devastating consequences.

Table 1 identifies red flags that should raise suspicion
of a serious disorder. [1]

Other red flags that are less likely to be associated with a life-threatening condition but that still warrant prompt diagnosis and appropriate management include:

  • pain that is worse with coughing
  • incontinence of bowel or bladder
  • urinary retention (inability to void or empty the bladder completely)
  • impotence
  • saddle anesthesia
  • intractable radicular pain into the lower extremity
  • rapidly progressive neurological deficit

The latter findings are common among patients with lumbar nerve root compression or cauda equina syndrome. Although serious, these disorders are seldom life threatening.


Step 1 –   Evaluate for Red Flags*
   
Table 1:   Red Flags of Low Back Pain   [1]

RED FLAGS
BLEED
INFECTION
TUMOR
1.   Duration greater than 6 weeks
X
X
2.   Age less than 18y
X
X
3.   Age greater than 50y
X
X
X
4.   Prior history of cancer
X
5.   Fever, chills or night sweats
X
X
6.   Weight loss (unexplained)
X
X
7.   IV drug use
X
8.   Recent surgical procedure
X
9.   Night pain
X
X
10.   Unremitting, constant, no relief
X
X
X
11.   Concomitant abdominal pain
X
X
X
12.   Lightheaded, weak, diaphoretic, disorientated
X


*   This is a list of red flags that may be associated with a
life-threatening disease.

     
It is not meant to include all the other red flags of lower back pain.


Step 1:   Evaluate for Red Flags   (Discussion)

  1. Duration greater than 6 weeks.   Intractable or progressive lower back pain lasting longer than 6 weeks should raise suspicion of a serious underlying condition. Radiographs (lumbar plain film series including coronal, sagittal and spot views) and routine laboratory studies will add a greater level of diagnostic accuracy to the evaluation. Basic laboratory studies to consider include comprehensive metabolic panel, complete blood count (CBC), C-reactive protein(CRP) or high sensitivity CRP (preferred), erythrocyte sedimentation rate (ESR) and urinalysis (UA). [2]

    If imaging and lab studies are normal and the patient has normal vitals, then serious disease is unlikely. Advanced imaging (MRI or CT) can be utilized if plain film radiography if felt to lack sensitivity. In the absence of serious disease, a mechanical lesion, central sensitization or psychosocial co-morbidities may explain on-going pain over 6 weeks in duration.

  2. Age less than 18 years.   Persistent pain in a pediatric patient is a red flag for tumor or infection if symptoms cannot be ascribed to a congenital abnormality or acute injury. Advanced imaging (MRI) and routine laboratory studies as noted above should be considered.

  3. Age greater than 50 years.   Although low back pain is common in this population, clinicians should be particularly alert to the patient that presents with a new onset of low back pain, whether or not a mechanical basis is identified. Intra-abdominal disorders (e.g. abdominal aortic aneurysm) and cancer are more common in this population. Although a mechanical lesion is more likely, older patients require a greater level of diligence to rule out serious disease.
    (
    see Table 1)

  4. Patient history of cancer.   Neoplasm involving the spine may present as unrelenting pain (i.e. does not improve with rest or analgesia) or pain that is worse at night. Cancer recurrence or metastasis to the spine should be considered when a patient with a prior history of cancer complains of unrelenting back pain. Advanced imaging (MRI) is valuable and early use may be appropriate if the index of suspicion is high. Basic laboratory testing can be helpful (e.g., elevation of alkaline phosphatase on a comprehensive metabolic panel and leukocytosis on a complete blood count). [2] A history of prior malignancy is the most informative of the all the red flags listed in Table 1 and may suggest active neoplasm as the cause of the individual’s back pain.

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Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

By |July 28, 2015|Diagnosis|

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2015 (Jun);   14 (2):   83–89

Andrée-Anne Marchand, DC, Jean-Alexandre Boucher, DC,
Julie O’Shaughnessy, DC, MSc

Université du Québec à Trois-Rivières,
3351 Boul. Des Forges. C.P 500, Trois-Rivières,
Québec, Canada, G9A 5H7


Objective   The purpose of this case report is to describe a patient who presented with acute musculoskeletal symptoms but was later diagnosed with multiple deep vein thrombosis (DVT).

Clinical Features   An 18-year-old female presented to a chiropractic clinic with left lumbosacral pain with referral into the posterior left thigh. A provisional diagnosis was made of acute myofascial syndrome of the left piriformis and gluteus medius muscles. The patient received 3 chiropractic treatments over 1 week resulting in 80% improvement in pain intensity. Two days later, a sudden onset of severe abdominal pain caused the patient to seek urgent medical attention. A diagnostic ultrasound of the abdomen and pelvis were performed and interpreted as normal. Following this, the patient reported increased pain in her left leg. Evaluation revealed edema of the left calf and decreased left lower limb sensation. A venous Doppler ultrasound was ordered.

Intervention and Outcomes   Doppler ultrasound revealed reduction of the venous flow in the femoral vein area. An additional ultrasonography evaluation revealed an extensive DVTs affecting the left femoral vein and iliac axis extending towards the vena cava. Upon follow-up with a hematologist, the potential diagnosis of May-Thurner syndrome was considered based on the absence of blood dyscrasias and sustained anatomical changes found in the left common iliac vein at its junction with the right common iliac artery. A week following discharge, she presented with chest pain and was diagnosed with venous thromboembolism. The patient was successfully treated with anticoagulation therapy and insertion of a vena cava filter.

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Identification of Internal Carotid Artery Dissection

By |February 27, 2015|Carotid Artery Dissection, Diagnosis|

Identification of Internal Carotid Artery Dissection in Chiropractic Practice

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2004 (Sep);   48 (3):   206-210 ~ FULL TEXT

Michael T Haneline, DC, MPH and Gary Lewkovich, DC

Palmer College of Chiropractic West,
Palmer Center for Chiropractic Research,
90 E. Tasman Drive,
San Jose, CA 95134
michael.haneline@palmer.edu


Internal carotid artery dissection (ICAD) is a condition involving separation of the artery’s intimal lining from its medial division, with subsequent extension of the dissection along varying distances of the artery, usually in the direction of blood flow. ICAD may produce cerebral ischemia due to occlusion of the involved artery. This occlusion may occur at or near the site of the dissection, or “downstream” as a result of embolization from a dislodged thrombus fragment. The problem any chiropractic physician faces in identifying ICAD patients is that the condition may present without any symptoms or the symptoms may appear benign (e.g., headache, neck pain or cervicogenic dizziness). Consequently, it may be impossible to identify some ICAD patients, especially in the early stages of the pathology. As the ICAD progresses and neural blood flow is compromised, the symptom picture typically manifests more completely. The chiropractic physician must be alert to characteristic findings of a progressing ICAD, since an immediate referral to a medical specialist may be required.

There are more articles like this @ our:

Stroke and Chiropractic Page


From the FULL TEXT Article:

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